Depression linked to costly chronic medical conditions and disability among aging minorities

More than 50 percent of older Chinese American immigrants experience depressive symptoms linked to increased disabilities and chronic health conditions, according to two new Rutgers studies.

The studies, published in the Journal of the American Geriatrics Society, examine the relationship between psychological well-being and the onset of disability and existence of comorbid chronic medical conditions among a cohort of roughly 3,000 older Chinese Americans aged 60 and older.

Researchers found study participants who reported depressive symptoms were more likely to suffer from onset of functional disabilities—the inability to perform activities of daily living—and mobility issues. They also found that comorbid depression and chronic health conditions increased emergency room visits and hospitalizations, worsened medical prognosis, and led to increased mortality.

"Depressive symptoms have extensive psychological and health consequences for older adults and the greater healthcare community," said lead researcher, XinQi Dong, director of the Rutgers Institute for Health, Health Care Policy and Aging Research. "Our studies suggest a bidirectional relationship between depression and disability, in which the conditions reinforce each other. Further, those suffering from depressive symptoms are more likely to engage in negative health behaviors, such as physical inactivity, obesity, and smoking, and are less likely to adhere to treatment regimens. This behavior further exacerbates their medical conditions and leads to increased use of health services.

"As their physical health declines, older Chinese Americans frequently turn to hospitals and emergency departments to treat their symptoms, which does not address the underlying depression," Dong continued. "Economic implications of increased hospitalizations notwithstanding, without proper screening for depression, symptoms are left underrecognized and untreated, leading to poorer health outcomes and even death."

"What is very evident from these studies is that mental health status compounds the health and well-being of older Chinese Americans and increases their cost of care," said researcher Dexia Kong. "Consequently, the integration of behavioral health and primary care is essential to effectively serve this population and prevent functional disability which even further exacerbates medical treatment."

Key findings:

• Approximately 50% and 54% of U.S. Chinese older adults experience various levels of functional disability and depressive symptoms, respectively.
• Depressive symptoms are twice as likely to occur in older Chinese Americans suffering from chronic medical conditions like heart disease, stroke, cancer, diabetes, and arthritis.
• Comorbid depression and chronic health conditions increase emergency room visits and hospitalizations among older Chinese Americans.
• Older Chinese American Women are more likely to experience comorbid depression and chronic health conditions
• Comorbid depression is associated with a six-fold higher likelihood of functional disability, a 70% increase in overall medical costs, and a 2.4-fold increase in mortality than those without depression.

"Depression disproportionately affects older Chinese Americans, which puts them at significant risk for developing functional disabilities and chronic health conditions," said Dong. "Our studies demonstrate the need to develop culturally appropriate interventions and screenings to address depressive symptoms and reduce the onset of disability in minority populations. Mental health professionals and primary care providers must work collaboratively to address vulnerable minority populations' diverse care needs. By working together, healthcare providers can provide a more equitable standard of care to all patients."